MAINTENANCE REQUEST FORM

Day Month Year H H M M NUMBER:

SHIFT A B C DATE: REPORTING TIME:

M/C Description: SHOP:

Name Of Supervisor B/D Category:ELECTRICAL/ELECTRONICS/MECHANICAL/HYDRAULIC/PNEUMATIC/OTHERS CRITICALITY

Normal Urgent
Brief Description Of Breakdown:

SERVICE FORM
Fault Description:

Action Taken:

Reporting Work Start M/C Handed Down Delay Net Down Machine Attended By
Time Back Time Time Time
Date Time Date Time Date Time Hrs. Hrs. Hrs.

M/C O.K. M/C Under observation 1.Man Power Not Available

DELAY 2.Spares Not Available
REASONS 3 Required Tools Not Available Signature Maint. Engg.
4.Due To Service Engineer Yes No
5.Non Availability of Machines
Signature Production Engg 6.Others Why Why Analysis Required
Result of Why Why Analysis-:

P HIN EX 35 11-8 Rev. 00

Issue date : 31.05.2011